by Uzra Khan:
BALI—At several places along the narrow, winding roads of Ubud, alongside stores selling intricate woodcarvings, silverware, butterfly kites, and plates of steaming fried rice, small white boards bearing the Red Cross symbol catch the eye of passersby, beacons of the presence of modern, western health-care on the island.
These niches of sterilized medical equipment, engineered drugs, and hospital beds are a contrast to what lies in alleyways nearby. Amidst small residential communities, hundreds of balians—medicine men and women—make use of natural ingredients and their knowledge of traditional methods of healing to cure locals.
The dichotomous systems of healthcare exist in symbiosis, catering to a large and sometimes overlapping clientele; many Balinese make use of both facilities, depending on circumstances and the particular illness.
Despite improvements in modern healthcare in the past decade, the people of Bali remain deeply rooted in their customs and beliefs, especially regarding healthcare. Religion is an important part of all aspects of life on the island: Each residential community has its own temple, which serves as the center of public life. The island boasts some 20,000 temples, each elaborately carved and decorated. Outside the door of every home and shop a small box of flowers and fruit called a charpang serves as an offering to the gods.
The Balinese brand of Hinduism is a mix of ancient local customs and Hinduism from South Asia, incorporating not just the mythology and philosophy of traditional Hinduism, but also black magic, animism, and witchcraft. This cocktail of beliefs is central to the lives of the Balinese people and shapes cultural attitudes toward many aspects of life, including healthcare. Nyoman urip, a local driver, commented on the Red Cross symbols: “Oh I hadn’t seen those before. They must be clinics. But I go to my balian, he is very good. If you are sick, I can take you to the hospital. I just got insurance.”
Bali’s eight administrative regions did not have the authority to establish efficient local medical services until the decentralization of political authority in 2001, when healthcare reform spread across Indonesia, making smaller outlets, pharmacies, and clinics accessible to local people. The Red Cross signs on the streets are symbolic of this reform.
These smaller clinics emerged as a middle ground between intimidating, large hospitals and traditional medicine men. But to those accustomed to western medicine it may seem incongruous for someone with medical insurance like urip to continue visiting a traditional medicine man.
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Balians are said to possess sakti, or spiritual power, and are deeply revered by the people of Bali. using a blend of herbs and natural ingredients like cinnamon, cloves, ylang ylang leaves, guava, and natural oils and essences the balians tend to almost any illness or personal problem. Rituals and mantras from Balinese Hinduism are a powerful supplement to the herbal tools. Balians specialize in various practices: some have studied ancient palm leaf manuscripts of medicine, or usadas, while others acquire knowledge through divine inspiration. Some mend broken bones, some are midwives, and some even take on the role of the priest in their community, conducting ceremonies like baby namings, marriages, and cremations.
Balians are so widely renowned and respected that for many Balinese the decision between modern and traditional medicine is simple. Putu Aroh, a Balinese hotel employee, claimed that hospital beds in Bali are filled mostly by tourists. “Only tourists believe in science. I go to balian with all my problems. If he tells me to go the hospital, I’ll go. But he only says that when I have fever, or to get an injection.”
Ketut Liyer, a medicine man in ubud made famous by Elizabeth Gilbert’s book “Eat, Pray, Love,” is a ninth generation balian usada who also has a longstanding distrust for modern medicine. Instead, he practices the ancient palm leaf medicine manuscripts of his ancestors. “I was sick when I was young once,” he said. “My hand was burned, and the hospital’s medicine didn’t help me. They were too smart for me! That night, my ancestors came to me in my dream and told me what to put on my arm, and I have been curing people since then. I only send patients to hospital if I cannot cure them myself.”
“Liyer’s arsenal includes different oils for patients to smell if they have insomnia, headaches, or high blood pressure. “I could tell what their illness is by looking into their eyes. But now I am old,” he said, revealing a toothy smile. A self-proclaimed artist, Liyer paints magic paintings that Balinese families display in their homes to keep sickness at bay. These medicinal works of art also prevent “family sickness”— discord among family members, and marital problems.
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In explaining his use of both traditional and modern medicine, Urip said, “I like going to balian because they try to find out what the problem is, not just cure it like the hospitals do. But if you need fast care, you go to hospital. If my son were ill, I’d go to hospital, because balian take time to heal. That’s why I got insurance.” urip’s healer of choice is a medicine woman, Wayan, who was also featured in Elizabeth Gilbert’s book. “She charges a lot more after the book, though,” he said.
In an economy that has been severely affected by multiple natural disasters as well as the global financial crisis, the price of allopathic healthcare is on the rise. The flexibility of payment for traditional means of healing is a major attraction for many Balinese, especially the poor. The fee for seeing a balian is quite variable: Patients often pay as much as they deem appropriate, or as much as they can. Conversely, very few Indonesians can afford medical insurance for modern healthcare, and only the poorest of the poor are eligible for Medicare health cards from the government. “Hospitals are becoming more and more expensive and impersonal, which makes local people suspicious of western medicine,” said Dr. Bayu Widhiartha, who works at a local hospital.
“Eat, Pray, Love” was a huge success, recently released as a movie starring Julia Roberts and drawing much attention to the ways of medicine and healing in Bali. The spotlight has drastically changed the lives of Liyer and Wayan, as well as other balians. Liyer, who is old and effectively unable to practice, spends his days entertaining ‘Eat, Pray, Love’ fans who flock from all over the world to have their palms read and take pictures with him. Publicity for Wayan, however, has brought changes to her methods of healing. In her house in ubud, a shelf full of professionally packaged medicines sits adjacent to an array of planted herbs. She carries with her a typed flyer advertising the services she offers, ranging from pricy four-hour treatments targeting tourists to cheap healing massages and consultations for Balinese. “Some other balian in ubud are also trying to be like Wayan, to have proper packaging and Western explanations,” said urip.
International publicity and an influx of tourists have certainly brought change to the ancient ways of medicine in Bali. While widespread cultural resistance to Western medicine has hindered its adoption, cooperation between the modern and traditional systems have been mostly unsustainable as well. A solution to Bali’s health-care dilemma seems far off. In the meantime, the system remains in flux.
Uzra Khan ’12 is a Psychology and International Studies major in Trumbull College. Contact her at uzra.khan@yale.edu.